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Prognostic factors of pediatric endoscopic sinus surgery
Hyo Yeol Kim1, Hun-Jong Dhong, Seung Kyu Chung
1Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong Kangnam-ku, Seoul 135-710, South Korea.
Insights
Severe nasal polyposis, advanced CT staging, and secondhand smoke exposure predict poor outcomes in pediatric endoscopic sinus surgery (ESS) for chronic rhinosinusitis.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Rhinology
Background:
- Pediatric endoscopic sinus surgery (ESS) treats chronic rhinosinusitis unresponsive to medical therapy.
- Prognostic factors influencing pediatric ESS outcomes require further investigation.
Purpose of the Study:
- To identify prognostic factors affecting outcomes in pediatric endoscopic sinus surgery (ESS).
- To analyze characteristics associated with good versus poor outcomes after ESS in children.
Main Methods:
- Retrospective review of 97 pediatric patients undergoing ESS.
- Classification of outcomes into 'good' or 'poor' based on postoperative endoscopic findings.
- Univariate and multivariate analyses compared nine patient characteristics between outcome groups.
Main Results:
- Overall success rate for pediatric ESS was 70%.
- Severe preoperative polyposis and high CT staging were linked to poorer outcomes (univariate analysis).
- Severe polyposis and indirect (secondhand) smoke exposure independently predicted poor outcomes (multivariate analysis).
Conclusions:
- Severe polyposis, advanced CT staging, and indirect smoke exposure are significant predictors of poor outcomes in pediatric ESS.
- These factors should be considered in the management and surgical planning for children undergoing ESS.
Objective:
Pediatric endoscopic sinus surgery (ESS) is performed for refractory cases of rhinosinusitis that do not respond to medical management. However, few studies have been reported for the prognostic factors affecting the outcomes of pediatric ESS. The aim of this study was to investigate the prognostic factors affecting the outcomes of pediatric ESS.
Materials And Method:
Medical records of 97 pediatric patients who had undergone ESS from February 1995 to October 2003 were reviewed retrospectively. We classified the patients into two groups based on outcome, i.e., either good or poor, according to the postoperative endoscopic findings. Then univariate and multivariate analyses were performed to compare the following nine characteristics between the good and poor outcome groups: the presence of allergy, bronchial asthma, adenotonsillar hypertrophy, history of previous sinus surgery, presence of a smoker in the family, degree of polyposis, preoperative disease extent scored by CT scan findings, blood eosinophil count, and eosinophil infiltration in the nasal mucosa.
Result:
The overall success rate was 70% based on the objective postoperative endoscopic finding. Statistical differences were found between the good and poor groups in terms of the degree of preoperative polyposis and CT staging in univariate analysis, whilst in multivariate logistic regression analysis severe polyposis and indirect smoking predicted poor outcome after pediatric ESS.
Conclusion:
Pediatric ESS with severe polyposis, high CT rhinosinusitis staging, or indirect smoking predisposes to a poorer outcome. This needs to be taken into consideration when performing ESS for children.
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